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[5] [11] Poor diabetes control from ineffective medication can lead to: Persistent hyperglycaemia with symptoms including increased thirst, frequent urination, and fatigue Elevated HbA1c levels, increasing the risk of microvascular complications (retinopathy, nephropathy, neuropathy) [16] [17] Greater likelihood of macrovascular complications (cardiovascular disease, stroke) Risk of hyperosmolar hyperglycaemic state (HHS) in some individuals with type 2 diabetes [20] [21] Additional concerns include the theoretical risk of increased impurities or degradation products, although there is no official link between expired Trulicity and specific toxic effects